MEDICARE: MR. CONRAD AU YOUNG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT19104	CA

General Provider Information

NPI Number	:	1952482648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CONRAD AU YOUNG PT

Provider Business Mailing Address
First Line	:	1090 SYRACUSE DR
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-2032
Country	:	US
Telephone Number	:	650-947-9646
Fax Number	:

Provider Business Practice Location Address
First Line	:	794 ALTOS OAKS DR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5401
Country	:	US
Telephone Number	:	650-947-9646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. CONRAD AU YOUNG PT” Practice Location

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